Do you suffer from one or more of the following:
- acid indigestion
- intolerance to certain foods (get gassy when eating certain foods)
- frequent belching, feeling full and feeling like the food just isn’t moving along after eating
- Gastro-Esophageal Reflux Disease (GERD)
- H. pylori infection
- frequently take antacid drugs
- fingernails crack easily
- vitiligo
- acne rosacea
- gum inflammation and receding gums (periodontitis)
- increased risk of heart attack
Millions of people suffer from the above and many are unaware that these could have this underlying cause: too little stomach acid… yes, too little, stomach acid production! Low stomach acid alone may not be the sole cause or the major cause of these problems. However, taking appropriate measures to restore proper stomach acid often results in significant improvement. You will not only feel better, but also improve nutrient flow to the rest of your body.
Stomach acid, which is also called hydrochloric acid or HCL, is necessary for many bodily functions. Low stomach acid is the condition where the stomach produces an inadequate amount of HCL. This condition is also called hypochlorhydria. Millions of people erroneously try to suppress HCL production by taking antacids. This is a common error made by people who decide to take antacids on their own, or doctors who prescribe them to people. This error has many dangerous implications for many systems of the human body.
I’ll provide a lot of information in this article which will cover the following:
- Why HCL production in the stomach is so important
- How it affects so many seemingly unrelated symptoms
- Why restoring proper stomach acid production is an important component for preventing some major health problems (included in the list above)
I’ll use a question and answer format so you can skip to the information you’re interested in.
Who is at high risk for low stomach acid (hypochlorhydria)?
Everyone knows that as we age, our body functions don’t work as well as as when we were younger. Those over 50 years old are at high risk for low stomach acid. It is estimated that about 75% of those over 60 have low stomach acid.
Those with allergies, asthma, and gallstones are also at increased risk for low stomach acid. Most chronic illnesses result in low stomach acid. In fact, in a recent study, the hydrochloric acid levels of “healthy” college students’ were measured, before and after getting the flu and periodically thereafter. The study showed that it took an average of 2 months for their HCL levels to return to their pre-flu levels.
How is low stomach acid diagnosed or identified?
The gold standard for determining low stomach acid is the Heidelberg test. This test has the patient swallow a tiny capsule, that contains a microtransmitter that measures the baseline pH (acid/alkaline level) of the stomach. The lower the pH, the more acidic. Next, the patient drinks a baking soda solution, and the transmitter measures the drop in acidity. The pH is recorded long enough to see how soon the stomach acid recovers to high acid levels.
There are comparison studies that compared symptoms of low stomach acid and blood tests with Heidelberg test measurements. The findings showed that symptoms of low stomach acid were often more important than Heidlelberg measurements in determining the need for HCL. The symptoms are:
- loss of appetite for high protein foods
- “acid stomach” relieved by eating
- bad breath and body odor
- gas shortly after eating
- indigestion 30 minutes to an hour after eating that lasts up to 4 hours,
- frequent visible undigested food in the stools
- difficulty digesting fruits or vegetables
- acid and spicy foods cause stomach upset
Jonathan Wright, MD, a pioneer in natural health care, has tested thousands of patients with the Heidelberg test. He has noted the following additional symptoms:
- slow hair growth
- chipping or cracking fingernails
- leg cramping
- nutrient deficiencies of folic acid, B6, B12, magnesium, calcium, iron and zinc
The stomach mixes food with HCL to break up large food paticles into smaller ones. HCL also breaks up food into its components for safe delivery to the small intestine. This helps prevent food allergies and is associated with decreased allergy responses.
Stomach acid is needed to cordinate signals to the nervous system for opening and closing the lower esophageal sphincter (the muscular-valve from the esophagus to the stomach). HCL is also necessary to effectively coordinate the stomach’s exit valve, the pyloric sphincter, for opening and closing for passage of food into the beginning of the small intestine. Proper coordination of these valves prevents acid reflux, and GERD.
Just about all foods we eat have a small amount of foreign bacteria. Unless the bacteria are enough to cause symptoms, we often don’t even notice it because the HCL kills the foreign bacteria. Some foreign bacteria are more harmful than others. Helicobacter pylori (H. pylori) is one of those more harmful. It is the causative agent of stomach ulcers. If H. Pylori remains in the stomach for long enough, it is directly implicated as causing stomach cancer. H. Pylori also lowers stomach acid. Low stomach acid predisposes to H. Pylori infection and other GI bacterial, yeast and parasitic infections 1. Stomach HCL also prevents pathogens from getting down farther into the small and large intestines.
According to Dr. Wright, “it’s been my clinical observation that calcium, magnesium, iron, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum, cobalt, and many other “micro-trace” elements are not nearly as well-absorbed in those with poor stomach acid as it is in those whose acid levels are normal.”
What are the indirect functions of HCL?
The stomach also produces digestive enzymes to help break down proteins into amino acids. Pepsinogen is released in coordination with HCL, which helps change pepsinogen into the enzyme pepsin. Pepsin is the gastric digestive enzyme.
Special cells in the stomach working properly are also necessary for vitamin B12 absorption. These special cells require HCL to work properly. Low vitamin B12 is associated with elevated blood cholesterol and homocysteine levels.
Gastrin is a hormone produced in the stomach that stimulates movement of food through the stomach. Chronic antacid use hinders both HCL and gastrin secretion, predisposing to low tissue amino acids. Since immunoglobulins are made from amino acids, low tissue amino acids impairs the immune system. Low tissue amino acids also causes muscle wasting, often seen in the aged or physically debilitated.
What is the connection between inadequate HCL production, receding gums and heart attacks?
Low stomach acid is associated with the development and progression of systemic inflammation and receeding gums, called periodontitis 2. Periodontitis is associated with increased incidence of heart attacks due to systemic inflammation 3 4.
What are antacids for? How long should I use them?
Antacids were only developed for, and are only supposed to be used for 8 weeks or less in most cases and 6 months at the maximum. The actual recommendation from the drug prescription instructions from the Physicians Desk Reference (PDR) for a common gastric medication:
Prilosec (Omeprazole) is prescribed for the short-term treatment of stomach ulcer, duodenal ulcer, erosive esophagitis (inflammation of the esophagus), heartburn, and other symptoms of gastroesophageal reflux disease (GERD).
Longer term use predisposes to multiple vitamin and nutrient deficiencies 5 6.
The usual dose for people with symptoms of GERD is 20 mg daily for up to 4 weeks. For erosive esophagitis accompanied by GERD symptoms, the usual dose is 20 mg day for 4 to 8 weeks. The dose may be continued to maintain healing.
Long-term use of Prilosec may cause severe stomach inflammation. Prilosec may mask the signs of stomach cancer.
Low stomach acid due to chronic acid suppression stimulates the chronic release of gastrin in the attempt to restore normal gastric acidity. This subsequently leads to chronically high gastrin levels that have been shown to induce cancerous tumors 7.
Prilosec OTC, an over-the-counter product, is approved only for frequent heartburn (occurring 2 or more days a week).
Note that the second recommendation contains the statement: “The dose may be continued to maintain healing”. Is a deficiency of Prilosec the cause of GERD? Not! Some may be led to believe that the drug maintains healing. In fact, it does not heal GERD in the first place. It only decreases the local conditions where the esophagus is no longer being irritated by stomach acid backing up into the lower espophagus which irritates the esophageal lining. This is a distinction that must be understood.
To heal erosive esophagitis, it would better to do so without decreasing HCL produced by the stomach. The details of how this is done using a Functional Medicine approach would require a whole article, so we’ll not go into that here. I plan to write and post a separate article about healing erosive esophagitis and the stomach lining here in my blog.
If you have low stomach acid and are prescribed supplemental HCL, how long do I have to take it? Can your stomach HCL production return to normal?
Betaine hydrochloride (Betaine HCL) is an acidic form of betaine, a vitamin-like substance found in grains and some foods. Betaine HCL with pepsin is used to increase the level of hydrochloric acid in the stomach. When taking Betaine HCL it should always be taken at the beginning or middle of a meal containing some protein. Often times, in patients in their 30′s and 40′s, taking supplemental betaine HCL can “jump-start” their stomach towards producing adequate HCL. Thus, they only have to use it for a short time. This can even occur in some of those over 50, if they tend to eat a good diet, exercise regularly, manage stress well, get adequate rest, etc. However, most don’t, so those over 50, often find great benefit in long term consistent use of supplemental betaine HCL with pepsin. The proper dose and correct timing in taking it with a meal make all the difference as to getting the most benefit without experiencing problems! This should be done under the guidance of a Functional Medicine and Certified Clinical Nutritionist professional who is familiar with Betaine HCL for GERD, digestive problems and disorders associated with low stomach acid.
Contact us, if you have any questions.
Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.holistichealthbayarea.com.
Copyright © 2009; Douglas Husbands, DC, CCN, ABAAHP. All rights reserved.
References
- Dial S, Delaney J, Barkun A, et al. Use of gastric acid-suppressive agents and the risk of community-acquired clostridium difficile-associated disease. JAMA. 2005;294:2989-2995. ↩
- Liu C, Hou L, Wong M, et al. Relationships between clinical parameters, Interleukin 1B and histopathologic findings of gingival tissue in periodontitis patients. Cytokine. 1996;8:161-7. ↩
- Kornman, K. Interleukin 1 genetics, inflammatory mechanisms and neutragenetic opportunities to modulate diseases of aging. Amer J Clin Nutrit. 2006;83:475S-83S. ↩
- Bokhari S, Khan A, Tatakis D, et al. Non-Surgical Periodontal Therapy Lowers Serum Inflammatory Markers: A Pilot Study. J Periodontology Online. 2009;80:1574-80. ↩
- Marcuard S, Albernaz L, Khazanie P. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Ann Intern Med. 1994;120:211-215. ↩
- Ivanovich P, Fellows H, Rich C.The absorption of calcium carbonate. Ann Intern Med. 1967;66:917-923. ↩
- Waldum H, Gustafsson B, Fossmark R, et al. Antiulcer drugs and gastric cancer. Dig Dis Sci. 2005;50 Suppl 1:S39-44. ↩
Very outstanding site.
The content here is genuinely helpful.
I will share it with my friends.
Cheers
Eat slowly and chew your food well. Do not be in a hurry to eat, always enjoy your food. This should help you treat belching naturally.
That is definitely a factor! Most people do not chew their food adequately before swallowing!
I just discovered that I’m not producing enough HCL and I’m only 32 years old! My ND recommended HCL + Pepsin capsules (THORNE brand). I’m kind of lost with the dose that I should be taking because no matter how many capsules I take, I still don’t feel anything. There is a maximum? Can you ever restore healthy HCL levels in your stomach?? I’m very worried because I get mixed messages about HCL and that it can be dangerous…On the other hand, I’m sick of bloating, belching, brittle nails and thinning hair, low energy, etc… My ND hasn’t been very helpful so I would really appreciate some info regarding this issue.
By the way, this article provides great info!!
Thank you very much!
2 hcl capsules are not enough for my.how do I figure out the right dose?
Hi Bonnie! You question has been emailed to Dr. Doug
I was also wondering if there is a maximum amount of pills to take. I took 15 and felt nothing.
Hello Jack! Your question has been forwarded to Dr Doug. He’ll send you a reply via email.
Happy New Year!!!
I am in despair at not being able to raise my stomach acid levels after taking betaine hcl tablets for months. I am a 50 year old female I have been losing my hair for 3 years and a trichologist performed many tests which showed adrenal issues, stomach issues and hypothryoid issues. The doctors do not seem to think there is anything wrong with me except perhaps stress. Having just done a bicarb of soda test – I had no reaction at all. I am taking an ethical nutrients tablet with 650 mg of betaine hcl and pepsin at lunch and dinner and it has clearly made no difference. I was concerned about taking more than the recommended dose but it seems I should try and see what happens. Could you advise at all? I would be very grateful of any help. many thanks.
Hello! We sent you an email but the email delivery failed. Please fill out our contact form on the right side.
Hello,
Since you have the Ethical Nutrients HCL and you are a 50 year old female, try increasing the HCL dose to 2 capsules at the beginning of meals. If there is still not difference after a couple of days, you may want to increase it to 3 HCL capsules at the beginning of meals. You should only increase the dose to where you feel just a slight warmth in your stomach, no more! When you feel that slight warmth with the dose you find elicits that feeling, then decrease the dose by one capsule…that will be the dose you need.
The adrenal and hypothyroid issues definitely need to be addressed also however. Look on my homepage at http://www.HolisticHealthBayArea.com and scroll down to the Hypothyroid and Adrenal pages to find useful articles I’ve written on those topics. With these combined issues, I would suggest we do a phone consultation.
did they test your vitamin D levels? Most of my stomach issues cleared up once I got my vitamin D levels to 50.
I am also a 50 year old female.
Kathy, Referring to your question to Celes asking her if her doctors tested her Vit. D levels: You are correct in that attaining adequate Vitamin D levels in the blood is a necessary component for proper stomach function.
It is also important for other health matters. The optimal levels of blood Vitamin D is 50 to 80 ng/ml to reduce breast cancer risk by 50 to 67%, according to Garland, CF, et al.J Steroid Biochem Mol Biol 2007;103:708-11.
Recently I had a bout of stomach pain. After thinking the flu had finally cught up with me I realized I had consumed a rather large ammount of steamed Rice the night before the stomach pain started.
Hmm I thought could all that rice absorbed too much stomch acid and therefore my food was just not digesting?
After no apitite and no bowel movement for 2 days I did my own test.
1 oz. of Balsamic Vinegar later the pain was releived and about an hour later a bowel movement and feeling much better the next day.
So could the consumption of some Acid in the form of Balsamic Vinegar have cured my over eating of some rice.
Something the doctors might want to look at as a cure instead of HCL.
Very interesting and helpful article
I seem to have a silent GERD issue that started a couple of months ago after a course of ibuprofen (4-5 weeks low daily dose for back / disc damage) prior to this I had never had any similar issues ever in my 45 years, I am a life time fitness / health enthusiast, and stay in great shape always, I never eat any processed food, unfortunately I blew my back when squatting! oh well, this is my first use of drugs ever and now they cause this : – (, originally the drugs caused wheezing / asthma which cleared after I used a liquorice and slippery elm supplement along with plenty of enzyme rich fruits,, but now I have this throat pain which seems to be caused by silent GERD?
Is there any information on how the ibuprofen causes such damage and how it can be fixed? what is stopping my HCL levels from returning to normal on their own? is it just due to a lack of certain foods? or do the drugs interfere with the chemistry involved?, my diet is 100 % organic fruit veg fish meat etc., I have refused to use any more drugs to try to remedy this
Is the article suggesting that certain food like rice will help restore HCL levels, I have not eaten much rice for a while, should I eat more and or supplement with the capsule to get thing back on track?
You mention a blog about how to heal erosive esophagitis has it been written I would like to read it.
Mark,
I replied to your e-mail directly yesterday, but am replying here also for others benefit. In brief, yes ibuprofen can disrupt the microflora and initiate the symptoms you are experiencing.
HELLO,
I am a vitiligo sufferer since three years ago.The last few months I started using betaine hlc along with various antioxidents (Selenium,B12,A,C,E,folic acid,milk thirsle,omega3,and pau d’arco).Since I started i can definitely tell that the progress of the disease has been halted.Still, it might need a longer period of time to be clear on that conclusion because it could well be a coincidence.A month ago, a dietologist that I know told me (when I mentioned to him my course of treatment) that the parallel use of Selenium,B12,A,C,E and even omega3 with betaine hlc could result in having sediment on the stomach,which is obviously undesired.Are you aware of such an issue?
I would appreciate any kind of comments on the above and generally on my approach.
Thank you
Dear Johnny,
I am so happy to hear the benefits you’ve attained from the nutraceutical regimen you’ve been using. I would encourage you to also make some of the dietary changes and Therapeutic Lifestyle Changes I’ve written extensively about in other blog articles on my website also, if you’ve not already done so.
Regarding the concern about “sediment in your stomach”, with those nutrients and HCL, that is not likely. Just use the HCL at the beginning of meals, and the selenium, B12, vitamins A, C, and E, folate, milk thistle, omega 3′s and others MID-MEAL. In other words, take a few bites of food and THEN take the other vitamins and nutrients with food.
i have had stomach problems for a long while now,gas,pain and just all around stomach upset,which usually feels better when i eat.i have had a g.i Dr. do an endoscopy with a biopsy,i did not have h pylori or ulcers i was told i had gastritis,and was put on dexilant.it helps some days and some days it doesn’t.i have had to cut down on coffee it is like pouring gas on a fire.i also have hypothyroidism.today i am in some pain,more like burning stomach,the GI Dr
said now they need to see what is causing this since i didn’t have h pylori,i may drink alcoholic drinks 3 times a yr and hardly ever take any aspirins or tylenol.i was wondering if maybe this could be contributed to my hypothyroidism?any help would be so appreciated,i have dealt with this for a couple yrs now.i do take meds for my hypo.
Brenda, I empathize with you with what you have gone through. Though your endoscopy may not have picked up H. Pylori, there are other pathogenic bacteria that could be causing GI tract problems that may have not been tested for. Also, consideration of parasites, fungi and yeast are often missed, through conventional testing, whereas the Functional Medicine laboratory tests I use often check for all these considerations, and more. We could have some of the functional laboratory stool test kits sent to you for you to take a stool sample and send it in the kit back to the lab. They would get the results back to me. This is how we can do remote consultations, for we have procedures in place to help you if you are not in the San Francisco, Palo Alto, San Jose area of California.
The GI problems can contribute to the hypothyroid problems and vice versa. We can determine possible solutions for that also with this Functional Medicine approach.
Wow, thanks for the informative blog.
For me to prevent digestive problems or diarrhoea, there are few words to always bear in mind: COOK IT, BOIL IT, PEEL IT, OR AVOID IT! Since ingestion of contaminated food is the number one cause of acquiring diarrhoea, and there are numerous ways of possibly getting them, taking precautionary measures on the food that you consume is a simple step that can take you a long way.
• First of all, if you are not sure or in doubt of the cleanliness of the water supply, don’t dare drink it, and this also applies to ice cubes and other iced drinks since you don’t have absolute assurance where the water used on making them came from. It’s best to drink sealed bottled, purified or carbonated water—and even use them for cleaning teeth. And when you are going to use regular water, be sure to boil it for one minute before consuming it.
• Cook thoroughly any food, especially meats and seafood and see to it to serve them piping hot. Remember that undercooked meats have high-risk of microorganism contamination, and foods left long enough in room temperature have high possibility to be contaminated.
• Avoid eating uncooked vegetables and fruits that are already peeled. It is best to choose raw fruits and veggies that you can peel yourself and salads made by you, just to prevent diarrhoea.
• Avoid unpasteurized milk and other dairy products, as much as possible. Boil milk before consuming it and take care with local cheeses and ice cream.
• Wash all the dishes and cutlery in clean hot water before using them and of course, wash your hands thoroughly with soap and clean water and don’t forget to dry them before eating or handling food, and always after using the toilet, holding money and touching possible contaminated objects.
• Seek hot, not just warm food and avoid foods sold in stalls in streets and places with poor hygiene.
It is also best to avoid alcohol and coffee as they can contribute to even worse case of diarrhoea.
I hope it helps.
Hi
I am writing this to you, because I have a question about the Betaine HCL. I purchased some a couple of months ago, but have only tried it once, then I discovered that you must be very careful about taking this because it can actually eat a hole in your stomach lining. I purchased it because I was desperate to try anything to help me with my bloating and indigestion. I have been having stomach problems for the last 6 years and cannot seem to get any help from the doctors! They just want me to take antacids and anti-depressants, which do not help with the bloating and only help minimal, if at all with the indigestion. I even tried prilosec and prevacid and after a few days, my symptoms seemed worse. And, I asked my doctor to test my stomach for low stomach acid and she said most people have too much stomach acid and she checked my vitamin levels. I am just afraid of taking the Betaine too long or too much. I don’t know how much is too much! And, granted I don’t know if I have low stomach acid, but over the years I have taken antibiotics at least 3 times a year or more for sinus infections, also for urinary tract infections and when I became so sick with my stomach problems, I was not taking care of myself at all. Couldn’t eat because I bloated immediately after eating and it was extremely uncomfortable. I was also abusing laxatives, because I was so bloated taking laxatives was a way to relieve my stomach. And, I also took some enzymes to help reduce my stomach acid because I was under the assumption I had too much stomach acid. I don’t know if you can offer any insight about the Betaine HCL based on what I have told you, but I stumbled on your website while searching for answers about bloating!! Thanking you in advance!!
Becky,
I’m sorry to hear about all the suffering you’ve experienced! As you can understand, your case is not as simple as the amount of HCL you take or not. I would suggest you schedule a phone consultation with me because there are many health issues you have brought up to answer how to resolve your current condition. Please reply using our contact form with your e-mail address, and we can send you the procedures and costs for phone consultations.
In the meantime, I’d suggest the helpful reading to understand more of the complexities in my blog posts:
http://www.holistichealthbayarea.com/blog/how-can-i-help-heal-your-gi-tract/
…and my main article from my Dec 2007 newsletter titled “Gut Health = Great Health” at http://archive.constantcontact.com/fs095/1101475329247/archive/1101895259294.html
Hello,
I’m only 22 years old. About 2 years ago my doctor prescribed me with Nexium, after I told him I experienced constant undigested food and acid coming out of my mouth. He claimed i had gastritis at the time. As soon as I took Nexium, I felt great – and I cut down on spicy food and oily food as well, so it was great.
It was so good that after about a year I gave up Nexium. But the symptoms never went away for good. Now I have difficulty sleeping at night because of bloating and undigested food coming up (and I rarely experience heartburn). But I don’t want to go back to Nexium – when I take it now, it gives me abdominal pain as well as several other side effects. In fact, I had a stomach flu a few weeks ago which I believe was the cause of re-starting Nexium. I’m beginning to suspect that I have low stomach acid.
So my question is this: is it possible for someone of my age to have low stomach acid? Is my stomach not producing enough acid because of taking Nexium for so long? And how can I get enough stomach acid to start proper digestion again?
Hello Usman,
Your experience with Nexium is not uncommon, even though you are only 22. That is the unfortunate result of trying to suppress symptoms without resolving the root cause of the problem. In fact, on February 8, 2012 the FDA notified the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile-associated diarrhea (CDAD). You may now have this problem, or another pathogenic bacteria influencing digestion.
For an answer to your question of someone your age having too low production of stomach acid, yes that is possible, and even likely depending on your diet and past use of Nexium. To resolve the problem and determine the key issues to resolve, you should seek a doctor who takes a Functional Medicine approach. If you are not local to the San Francisco Bay Area of California, we have procedures in place for remote phone consultations, including laboratory testing to verify root causes. You may use the contact form for further assistance if you’d like. ~ Dr. Husbands
Informative but I’m still waiting to read what exactly happens in the body to limit the production of stomach acid and what can be done other than supplements to remedy it. Also are there differences between types of Betaine HCL and pepsin supplements. I used one that seemed to work good and another that did not. What’s the proper dosage?
Can u recommend any doctor in New York City. I need to see one that really know about this issue and give me a accurate diagnosis